Diagnostic accuracy of color flow doppler in thyroid tumors

Objective: To determine the diagnostic accuracy of color flow Doppler in differentiating between benign and malignant thyroid nodules and using FNAC as gold standard

Study Design: Validation study

Place and Duration of Study: Radiology Department, Benazir Bhutto and Allied hospital Rawalpindi for a period of six months, from Mar 2013 to Sep 2013

Material and Methods: The validation study was done at Radiology department, Benazir Bhutto and Allied Hospitals, Rawalpindi for the period of six months from 13th March to 13th September 2013. A total of 130 patients presenting with thyroid swelling with at least one dominant nodule, belonging to either sex were included through non probability consecutive sampling

Results: Sensitivity, specificity, positive and negative predictive values as well as accuracy of color flow Doppler ultrasonography in detection of malignant thyroid nodule was 93.3%, 97.4%, 82.4%, 99.1% and 96.9% respectively. Area under the curve [AUC] was 0.935 [p=0.0001]

Conclusion: Color flow Doppler was found to be a useful diagnostic modality in the management of thyroid nodules, although the primary means should be FNA Biopsy

Optic nerve sheath diameter on sonography in idiopathic intracranial hypertension versus normal

Objective: To compare the mean optic nerve sheath diameter [ONSD] in patients with idiopathic intracranial hypertension [IIH] versus normal healthy individuals using B-scan ultrasonography as diagnostic tool

Study Design: Cross-sectional analytical study

Place and Duration of Study: Armed Forces Institute of Radiology and Imaging, Rawalpindi, Pakistan, from June to December 2015

Methodology: Participants aged 30 - 50 years were divided into two groups. Group A [GP] comprised of patients who were diagnosed cases of idiopathic intracranial hypertension while normal healthy adults who volunteered to participate in the study were included in Group B [GC]. Ocular B mode ultrasound scan was performed on all the participants and each eye was considered separately. The optic nerve head was visualized as a linear hypoechoic structure, and ONSD was measured 3 mm behind the retina. A total of three readings were taken by the same radiologist and the average of three was recorded. Mean values of both groups were compared by t-test with significance at p < 0.05

Results: Fifty-two eyes of 26 patients [26 eyes in each group] were included in the study. Twenty-four out of 26 in Group A [GP] and 23 out of 26 in Group B [GC] were females. Mean age of the patients was 33.92 +/-4.89 years in group A [GP] while it was 34.69 +/-4.79 years in group B [GC]. Mean ONSD was 6.61 +/-0.39 mm in group A [GP] and 4.33 +/-0.38 mm in group B[GC] which was significantly different [p < 0.001]

Conclusion: Ultrasound can provide a reliable, non-invasive tool to measure optic nerve sheath diameter in monitoring the patients with benign intracranial hypertension [BIH]

Frequency of abnormal hepatic venous waveforms in cirrhotic patients

Objective: To determine the frequency of abnormal hepatic venous waveforms in patients suffering from hepatic cirrhosis

Study Design: Cross sectional

Place and of Study Duration: Shafique Medical Centre Quetta and Radiology Department Combined Military Hospital, Quetta from December 15[th] 2009 to July 15[th] 2010

Material and Methods: The instrument used in this study was Toshiba Eccocee SSA-340A and ALOKA SSD- 5000 doppler ultrasound machines with linear and convex probes. Hepatic venous Doppler was performed with convex 3-5 MHz probe. Hepatic venous Doppler examination was performed by two radiologists [operators] on all the 135 patients with positive HCV, HBV, chronically raised amino transferase level and clinical and radiological features of cirrhosis, who independently and blindly recorded their findings. Nonprobability, purposive sampling was done. After Doppler ultrasonographic examination liver biopsy and histopathology of all the patients was performed. Data from each patient was collected on designed form for age, gender, types of hepatic vein waveforms and grades/severity of liver cirrhosis on histopathology

Results: 135 patients with maximum 50 years and minimum 41 years of age have mean age of 46.79 +/- 2.37. Out of 135 patients in 103 [76.3%] Type 1 [Triphasic] flow was observed in 3%, Type II [Biphasic without reduced oscillation] flow was observed in 29.6%, type III [Biphasic with reduced oscillation] flow was observed in 34.1% and type IV [Monophasic] flow noted in 33.33%. There was significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology [r=0.887, p< 0.001]

Conclusion: Hepatic venous Doppler is noninvasive tool which can be employed to assess the types of abnormal hepatic venous waveforms in patients with hepatic cirrhosis. There is significant correlation between hepatic venous waveform and severity of cirrhosis on histopathology

Salt toxicity [sodium intake]: a serious threat to infants and children of Pakistan

Excess sodium intake can lead to hypertension, the primary risk factor for cardiovascular disease. The aim of this study was to investigate the sodium and potassium contents of foodstuff used by infants and children of Pakistan. We analyzed the sodium and potassium contents of infant milk formula [<6 months], follow up milk formula [>6 months], baby food [cereals], biscuits, fruit juices, potato chips [crisps], cheese puffs, roasted cereals [salty], ice cream cones [kulfi] all of which are the processed food extensively used by the children. The amount of sodium and potassium contents in drinking water of few cities of Pakistan were also considered to assess the additional sodium/potassium in the preparation of milk using infant milk formula. Na to K ratio [Na:K] was determined 0.3-1.23, 0.3-1.16, 0.33-0.82, 0.54-2.68, 0.51-0.85, 2.86 and 1.02 for infant milk formula [<6 months], follow up milk formula [>6 months], baby food [cereals], biscuits, fruit juices, potato chips [crisps, cheese puffs, roasted cereals], ice cream cones [kulfi], respectively. The higher sodium content is present than most of the quoted values; whereas lower potassium is present than the recommended values. The higher Na:K ratio indicates the severity of the situation where it is commonly stated that "higher an individual's salt intake, the higher an individual's blood pressure". Present study indicates that nearly all Pakistani children consume substantially more salt than they need which will affect health status in later life

Hepatitis c among young male offenders admitted to the central jail, Lahore

This study was designed to observe intraprison incidence of hepatitis C virus [HCV] infection among young offenders admitted to the Central Jail, Lahore. The evaluation was made incidence among 728 young inmates [aged 16 - 30 years] at the Central Jail, Lahore, between June 2009 and November 2009. Screening for Anti-HCV antibodies was performed on immunochromatographic devices and all positive and borderline cases were retested with ELISA system. Among 728 participants, 129 demonstrated serologic evidence of HCV infection. Frequency was calculated 17.7%. The study indicates that HCV infection is highly prevalent among young male offenders and highlights the need to deliver awareness, prevention, and medical management to make them a healthy and useful citizen

Reviewing the usefulness of laboratory tests results in hepatitis C

Hepatitis C virus [HCV] infection is a common cause of chronic liver disease and is relatively frequent in certain populations. Liver disease progresses so slowly that a person can have hepatitis C for years without being feeling sick or having specific symptoms that would lead a clinician to suspect liver disease and diagnosis for hepatitis C often occurs only after they are found to have abnormal liver enzymes during routine blood workup or tested because of specific risk factors. Blood tests that assess liver function are frequently used to evaluate and treat patients with symptomatic and asymptomatic liver diseases. We scanned the literature in an effort to identify biochemical markers that may be helpful in the evaluation and management of chronic hepatitis C disease. This article discusses the utility and limitations of laboratory tests results in establishing the diagnosis and prognosis in HCV infected patients

MR image spectrum of spinal dysraphism in a military hospital

To demonstrate the spectrum of MR imaging findings in patients with suspected spinal dysraphism in a Military Hospital. Descriptive study. Department of Radiology, Military Hospital Rawalpindi from September 2005 to October 2007. Patients were referred from neurology, neurosurgery and general surgery departments of Military Hospital and Combined Military Hospital Rawalpindi who presented with various neurological problems and skin stigmata having suspicion of spinal dysraphism. A total of 74 patients were evaluated over a period of two years. All 74 [100%] patients suspected of spinal dysraphism showed one or multiple abnormalities out of the whole spectrum on plain MRI spine. Mean age was 6.4 years with the youngest patient sixteen days old and the eldest being 37 years old. Majority of the patients were under six years of age. A wide range of abnormalities were seen with Myelomeningocele found in 29 [39.2%] and along with lipomatous component in 9 [12.2%]. Thirty three [44.6%] patients had diastometomyelia, 10 [13.5%] having associated lipoma of filum terminale while syringomyelia was noted in 36 [48.6%] patients. Moreover, in the majority of patients, dysraphism was at the lower lumbar and upper sacral region. It was concluded that plain MRI spine is a single safe, non-invasive and quick method of describing the gamut of findings in patients of spinal dysraphism

Jail population; a survey for HBV, HCV and HIV infections

The infections with hepatitis B virus [HBV], hepatitis C virus [HCV] and human immunodeficiency virus [HIV] are common among prisoners but such data are sparse from Pakistan; hence in this study, we evaluated the sero-prevalence of these three infections among Jail inmates. Cross-sectional survey. Central Jail, Lahore. May to November 2009. Investigate the seroprevalence of HBV, HCV and HIV infections among the random population of sentenced inmates of Central Jail, Lahore. We examined 3062 jail inmates, 396 of them were females and 2666 males. Majority of the inmates were Pakistani national [97.06%]. All collected blood samples were tested for HIV antibodies, HBsAg, and anti-HCV antibodies with one step chromatographic immunoassay. Seroprevalence rate of HCV, HBV and HIV infections was 15.31%, 3.46% and 1.79% respectively. Overall prevalence of these infections in the jail inmates was 20.57% and 18.77% of them were positive for markers of viral hepatitis B/C. We evaluated that jail inmates in Pakistan had a high incidence of HCV, HBV and HIV infections. Regular testing is required to identify infected prisoners and refer them for appropriate treatment. In addition, general disease prevention efforts are needed to minimize transmission of these viral infections in this subpopulation, before and after release

Pulmonary varices - rare cause of haemoptysis

Haemoptysis has a long list of causes, but pulmonary varices are amongst the rare causes. Pulmonary varices are rare abnormalities of pulmonary veins that may exist either as an isolated malformation or in association with pulmonary venous hypertension. This case report describes pulmonary varices as a cause of hemoptysis in an adolescent boy, which was diagnosed on multislice CT and confirmed on angiography

HIV Infection, HIV/HCV and HIV/HBV co-infections among Jail Inmates of Lahore

Human immunodeficiency virus [HIV] infection constitutes an important prison health care concern but data on HIV epidemiology among jail inmates of developing world including Pakistan is limited. The present study was carried out to find out the prevalence of HIV infection among inmates of two jails of Lahore, Pakistan. Cross sectional prevalence survey of a total of 4915 jail inmates [4498 male and 417 females] was conducted during a seven months period, from May 2009 to November 2009 in the inmates of "District and Central Jails of Lahore". They were divided into four groups according to age. A blood sample was collected from each survey participant. All collected blood samples were screened for HIV antibodies, HBsAg and anti-HCV with rapid testing immunochromatographic [ICT] kits. All positive test results were confirmed by using the ELISA technique. The overall HIV prevalence rate was 2.01% and 77.78% of them had co-infections. HIV/HCV co-infection was detected in 73.74% of HIV positive inmates. Among women prisoners, one Pakistani and four Africans were found HIV positive. HIV infection and HBV/HCV co-infection was more prevalent in the age group 16-30 years. The prevalence rate of HIV infection and its HBV/HCV co-infection in jail inmates is much higher than the general population and the prevalence rate reported earlier from other jails in Pakistan. Health information on jail populations is important as this is a vulnerable group, with frequent movement in and out of the general community. Urgent prevention efforts are needed as HIV prevalence is already 2%

Validity of ultrasound in diagnosis of liver fibrosis resulting from chronic viral hepatitis

To determine the validity of ultrasound in diagnosis of liver fibrosis associated with chronic viral hepatitis, considering histopathological findings as gold standard. Validation study. Department of Radiology, Military hospital Rawalpindi, from March 2007 to February 2008. Patients with positive laboratory findings of viral hepatitis were sonographically evaluated in Radiology department in lying position with 2-5 MHz frequency convex and 5-12 MHz frequency linear probes of Aloka prosound [ssd] 5500 ultrasound machine. An Ultrasound scoring system using both the low and high frequency probes was performed by evaluating the edge, surface and parenchymal texture of the liver. Each score was obtained by evaluating three parameters; the bluntness of the liver edge, the irregularity of the surface and coarseness of the parenchymal texture were evaluated and then compared with the histological findings. Amongst 50 patients with history of chronic viral hepatitis, 31[62%] were males and 19 [38%] were females. Ages of patients ranged between 26-60 years [mean 40.8 years]. The US [ultrasound] accumulated scores of the liver edge, liver surface and liver parenchymal texture were compared with the fibrosis stage obtained based on the biopsy findings. The accumulated US scores of these three parameters [fibrosis stage 0-IV- No fibrosis, mild, moderate and sever fibrosis] however, were found to be the most reliable indicator. Thirty Two [64%] patients showed true positive, 4 patients [08%] showed false positive, 09 [18%] patients showed true negative and 05 patients [10%] patients showed false negative results. [Table .1] Sensitivity, Specificity, positive predictive values, Negative predictive values and accuracy of Ultrasound in diagnosis of liver fibrosis were calculated to be 86.48%, 69.23%, 88.88%, 64.28% and 82% respectively. [Table.2] Ultrasound evaluation of the liver fibrosis stage based on the scoring system using both low and high frequency probes has been found to be a reliable and effective alternative to the histological staging in chronic liver disease

Diagnostic accuracy of magnetic resonance imaging in meniscal injuries of knee joint and its role in selection of patients for arthroscopy

Magnetic Resonance Imaging [MRI] is frequently advised to evaluate clinically suspected cases of meniscal injuries in our setup. The objective was to determine the diagnostic accuracy of MRI in meniscal injuries of knee joint and its effectiveness in selection of patients for arthroscopy. A Cross-sectional comparative study was conducted at Radiology Department Military Hospital [MH] Rawalpindi in collaboration with Orthopaedic Department Combined Military Hospital [CMH] Rawalpindi from 31 Jan 2007 to 1 Aug 2007. Fifty-seven patients with clinical suspicion of meniscal injuries were subjected to MRI. Arthroscopy was done only in 34 patients while 23 were excluded on the basis of MRI findings. MRI findings were compared with arthroscopic findings. Medial and lateral menisci were considered separately in each case. Among 57 patients only 30 showed significant tear on MRI. Arthroscopy was done in these cases. Arthroscopy was considered on clinical grounds only in 4 patients who did not show significant tear on MRI. MRI showed Medial Meniscus [MM] injury in 23 patients and Lateral Meniscus [LM] injury in 10 patients. Arthroscopy confirmed MM injury in 17 patients and LM injury in 7 patients. MRI missed two MM and one LM injuries. This showed that MRI has sensitivity of 89.4% and specificity of 62% in diagnosing injuries of MM, while sensitivity of 87% and specificity of 88% in diagnosing injuries of LM. Diagnostic accuracy of MRI in MM and LM injuries was 76.4% and 88.2% respectively. MRI is accurate in diagnosing meniscal injuries of knee joint and is effective in selection of patients for arthroscopy

Validity of colour doppler ultrasonography with d-dimers in clinically suspected deep venous thrombosis of the lower LIMB

This study was designed to evaluate the validity of colour Doppler ultrasonography with D-dimers in clinically suspected deep venous thrombosis of the lower limb. Validation study Place and Duration of study: Radiology Department CMH/MH Rawalpindi Six months from 15 June 2006 to 31 December 2006. Subjects and Thirty cases of clinically suspected deep venous thrombosis of the lower limb were included in the study selected on non probability convenience sampling technique. Colour Doppler ultrasonography examination of the affected lower limb was carried out and results compared with D-dimers assays results. Among 30 patients who underwent colour Doppler ultrasonography examination of the affected limb for diagnosis of deep venous thrombosis, 27 [90%] were diagnosed to have deep venous thrombosis, 3 [10%] were diagnosed not to have deep venous thrombosis. Amongst them 2 patients had raised D-dimers levels and repeat Doppler ultrasound advised. On revised ultrasound deep venous thrombosis in these patients was confirmed. This showed that colour Doppler ultrasonography examination has sensitivity of 93.1%, specificity 100%, positive predictive value 100%, negative predictive value 33.33% and overall accuracy of 93.33%. Colour Doppler ultrasonography has a high diagnostic yield in cases of deep venous thrombosis of lower limb when used in conjunction with D-dimers assays

Comparison of helical computed tomography and ultrasonography in diagnosis of acute appendicitis

The objective of study is to compare the diagnostic accuracy of helical computed tomography and ultrasonography in acute appendicitis using histopathology as gold standard. Validation study. Department of Radiology CMH/MH Rawalpindi, from 06 April 2007 to 02 January 2008. Thirty cases of clinically suspected acute appendicitis were included in the study selected on non probability convenience sampling technique. Computed tomography and graded compression ultrasonography of right lower quadrant of abdomen were conducted and results compared with histopathological findings. Amongst 30 patients who underwent computed tomography and graded compression ultrasonography examinations of right lower quadrant for diagnosis of acute appendicitis, on computed tomography 19 were diagnosed with acute appendicitis, 10 were diagnosed as not having the disease and 01 patient diagnosed as not having appendicitis on computed tomography did not improve clinically, was operated upon and histopathology proved it as acute appendicitis. While on graded compression ultrasonography 15 were diagnosed with acute appendicitis, 11 were diagnosed as not having the disease and 04 patients diagnosed as not having appendicitis on ultrasonography, did not improve clinically, were operated upon and histopathology proved it as acute appendicitis. This showed that CT scan has sensitivity of 95%, specificity 100%, positive predictive value 100%, negative predictive value 90.91% and overall accuracy of 96.67% while ultrasonography has sensitivity of 78.9%, specificity 100%, positive predictive value 100%, negative predictive value 73.33% and overall accuracy of 86.67%.We concluded that Helical computed tomography is highly accurate in diagnosing acute appendicitis as compared to ultrasonography and it helps to reduce negative appendectomy rate

inquiry into the cosmic origins of the human life and interpretation of the first seven ayahs of holy Quran's chapter "at-Tariq" in this context

This research article briefly reviews the current literature and ideas from the sciences of Astronomy, Astrobiology and Astrochemistry, regarding the synthesis of the Basic Chemical Elements. The elements heavier than He are synthesized in the large stars and these elements are ejected into space, to far distances, through Supernovae explosions. These stars are the factories of the "Stardust" which provide the materials necessary for the creation of Life and hence us Humans! Although these concepts have taken concrete shape very recently due to the advent of ultramodern theories, equipment, and discoveries, it is proposed here that the Holy Quran has pointed to the same phenomena, about one and a half millennia ago

Crossed fused renal ectopia with staghorn calculus and gross hydronephrosis

Crossed fused renal ectopia is a rare renal anomaly. Formation of staghorn and struvite calculi within it has never been reported in local literature. A 25-year-old man with macrohematuria and right flank pain was admitted to the hospital. An intravenous pyelography revealed right sided crossed fused ectopic kidney showing a staghorn and struvite calculi in upper-moiety along with gross hydronephrosis. Patient was conservatively managed after exclusion of other congenital anomalies

Hepatitis B antigenaemia

The prevalence of hepatitis B virus infection is a global health issue including Pakistan, causing considerable morbidity and mortality from its chronic sequelae including chornic hepatitis, cirrhosis and liver cancer particularly when HBV infection is acquired early in life. The present study was undertaken with the object to find out the current HBV infection rate and any age and sex differentiation in the population of Faisalabad. This studied was carried out at Madina Teaching Hospital, Faisalabad, from May 2005 to April 2007. A descriptive, hospital based study. Blood was collected by approved medical techniques for HBsAg immunochromatographic devices were used to screen blood. HBs antigen positivity in Faisalabad is currently 1.55%. A significant majority of reactive cases belonged to the male gender [72.91%] and the young age groups 2-4 [43.75%]. Upon analyzed the results of this study, it was revealed that the number of HBV infected subjects isolated is rather low in this area but the given figure is still notable in view of its high prevalence in the young age group